1986, 10-28 Permit App: 00013939 Garage, Storage(THIS IS NOTA FERMI. )
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF i HE FORM YOU UNDERSTAND
Sr' COMPLETE IN INK
(Please return this original and your building plans to the Department of Building and Safety)
SHADED AREAS ARE FOR DEP
11
Project Number ' q9
Owner's Name LAST FIRST MI
Ken d o4( .Tamm L •
Project Address (Street Name & Number)
Zip
2812 N. Cen/cr Rd SPokdne. a° 44212
Applicant
Ken dal l f ries L
Address
2 8 N
12 Ceniter 22.
City 1 State
SPolc&rit i \.t/ a- j Zip 99212
Phone (509) 92y ?Go'f
Business Phone
(Soy/ 4154 4390
Contractor/Agent _ Adrf. ess
him aa; .con — CerntnV erycre% 38 23 N. •Edger i e n 'Rd
City
,SPeko.ne
State
ur`as L.
Zip
99212
Phone -
Soy )A7154%0 0
Contact
License Number (neer i:ed)
Busine=ss Phone
1$0 Q ) 92''( 3900
ArchitectlEngineer
Address
City State I Zip -
Pnone _
Contact
Business Phone
1
Lender
Ado ess
City..
State
ip
Phone -
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DEPARTMENTAL REVIEW
1 certify that I have examined this application and state that the information contained in it and submitted
by me or my agent to compile said application Is true and correct.
Signature Date
Approved
Cond.
Approval
—
Hold
,
/0
Application # �
•/o $(s
cnvirdmental Health
W. 11 1 College
�µcr—�(ljNl _
//
Roonj'200 4
-
!:___
W re 4
i f
I
Planning/Zoning �_. - N. 721 Jefferson 's
v
Engineers
N. 811 Jefferson
Utilities -
N.811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
Other (SEPA/Critical Material/etc.)
Fast Track/Special Inspection Information
Project Representative
I Phone
Address
1 certify that I have examined this application and state that the information contained in it and submitted
by me or my agent to compile said application Is true and correct.
Signature Date
QP
OP
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PanoosED NE
GARAGE
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tato S4 Fr
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P/_ 4 F'en61n9—
OLD texi5hN
"-ARA GE TO
6E REMOVED
$).4 F,.
9-
Z.11.1 -CEN DA LL.
28 12 N ccn.tcr Rd
Sas] e • - 20'